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Home My WebLink About224917 10/08/2013 »,f CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1 ONE CIVIC SQUARE HENRY SCHEIN INC CARMEL INDIANA 46032 DEPT CH 10241 CHECK AMOUNT: $2,253.53 , PALATINE IL 60055-0241 CHECK NUMBER: 224917 CHECK DATE: 10/8/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 102 4239011 5526927-01 458 . 03 SPECIAL DEPT SUPPLIES 102 4467006 5526927-01 1, 795 . 50 EMS EQUIP 02HENRY SCHEIN' SHIP TO/SOLD TO: EMS Carmel Fire Department MI 135 Duryea Road, Melville, NY 11747 ®� 540 W 136th St Station 46 Michael Kaufmann Carmel,IN 46032-8806 010000130857105526927110010000002253530913136 BILL TO: Carmel Fire Dept MI 2 Civic Sq Carmel, IN 46032-7543 Carmel Fire Dept BILL To I SHIP To I INVOICE AMOUNT 2 Civic Sq Carmel, IN 46032-7543 1308571 1817102 2253 .53 INVOICE# I INVOICE DATE 5526927-01 9/13/13 CUSTOMER PO# MARK HSI ORDER# ORDER DATE DUE DATE 12646253 09/13/13 10/13/13 D&B#:01-243-0880 WHSE DEA# RH0162494 Fed ID: 11-3136595 s >., ��yA�.,:�:.:.::.::m..f8 :: �,- ..p.':!✓..,...:::c:�r f;:'"r,,,:,::?-::::<:c:::....�. ........ his order has been processed by our MIDWEST D.C. 5315 WES 74TH STREET INDIANAP LIS,IN 46268 RK 317-57 -2663 17-428-878 ---------- --------------------------------- ------ ----- ------------- ------- 1 987-8154 PU 100/BX SYR DISP 3CC W/22X11/2 LUERLCK 2 2 * 12.10 24.20 6 2 101-5979 6/BX CLOTH SURGICAL TAPE 2"X10YD 12 12 C 7.77 93.24 7 HIS PRODUCP IS BEING SHIPPED FROM OUR NORTHEAST DIS RIBUT ON CENTER. ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. 3 166-0251 100/BX BANDAGE CAREBAND ADH STRP 1X3" 12 12 C 1.07 12.84 1 LEASE NOTE 1126133 IS NOW 1660251 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. 4 935-6155 50/PK BLUE SENSOR SP ELECTRODES 150 150 11.97 1795.50 6 5 890-6800 EA SHARPS SHUTTLE SINGLE USE P2 25 25 1.61 40.25 6 6 602-8100 EA COLLAR STIFNECK SELECT ADULT 50 50 C 5.75 287.50 5 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. HE PRICES 3TATED ABOVE MAY REFLECT A DISCOUN OR BE SUBJECT TO A REBATE YOU UST FULLY D ACCURATELY REPORT THIS STATED DISCOUNr PRICE, OR IF APPLI ABLE, Y NET PRI ING, AFTER GIVING EFFECT TO ANY REBATES, TO ME ICARE, MEDICAID, RICARE AND ANY OTHER FEDERAL OR STATE PROGRAM UPON EQUESI BY ANY SUCH PROGRAM. IT ISYOUR ESPONSIBILITY TO REVIEW ANY AGREEMENTS OZ OTHE DOCUMENTS AP LICABLE BILL TO SHIP TO INVOICE INVOICE AMOUNT ITEM STATUS KEY REM KEY 13-nackordered:Item will follow SK-School Kit 1308571 1817102 5526927-01 2 2 5 3 .5 3 D-Discontinued:Item no longer available Nc-No charge h-Special Schein Free Goods HSI ORDER# ORDER DATE INVOICE DATE # OF BOXES M-Manufacturer will ship Item directly to you 1'-Prescription Drug;Return Authorization Required 12646253 09113113 9/13/13 7 R-RefngeratedItem:Maybeshippedseparately $ -Special Schein Pricing CUSTOMER PO# PAGE# T-Taxable Item Temporarily unavailable;please reorder MARK 1 OF 2 • -Item has MSDS Continued on Next Page.......... 12646253 09/13/13 10/13/139 o&o#:u/'z4s-0ann TO THESE PZICES TO DETERMINE IF THEY ARE SUB,TECT TO A REBPTE. THE FEDERAL 3OVERNMENTI14POSES CERTAIN RESTRICTIONS ON, AND REQ=ES PUELIC REPORTING OF, DISCOUNT PR)GRAM (E.G. POINTS, DISCOUNT REDEM)TIONS )R OTHER SPECIAL AWAI"DS) , ITH YOUR P JRCHASES YOU MAY EARN POINTS/CREDI 'S REDE EMABLE FOR CERTAIN GOODS OR SERVICES, Ii ACCORDANCE WITH DISCOUNT PROGRAM RULES. UPON DISCOUNT RECEIPT BY REDEMPTION )F YOUR EARNED POINTS/CREDITS, YOU ARE RE-EIVINC OR WILL RECEIVE NTOTICE OF TiE DISCOUNT VALUE. ACCORDINGLY, YOJ SHOUL) RETAIN THESE RECOR)S. 11 WEAVER R)AD DENVER, PA 17517 MERCHANDI E TOTAL 2253.53 Invoice Date + 30 days 2253.53 Please remi payments only to the following aldress: Henry Scheii, Inc. Dept CH 102 1 Palatine, 1, 60055-0241 BILL TO SHIP TO INVOICE# INVOICE AMOUNT ITEM STATUS KEY REM KEY, 1308571 1817102 5526927-01 22S3 .53 :)- )iscontinued tem no longer available NC-No Charg F-Special Schein Free Goods HSI QRDER# ORDER DATE INVOICE DATE # OF BOXES M-Manufacturer�vili ship item directly to you 1) Prescription Drug:Return Authorization Required 12646253 09/13/13 9/13/13 7 R Refrigerated Item:May beshipped separately $ Special Schein Pricing Temporarily unavailable;please reorder MARK F- 2 OF 2 Item has MSDS <'eqy Ir,rat: g:; ;'„ 5: Y^a make>very 0 0?o maintaill prices`;,r the dijrat o of a ,payment by CHECK or by the HENRY SCHEIN CREDIT CARD, catalog, ':oi,EBVer,,y,,e resert'e t'e E'ivht p make pride adj ustments VISA,MASTERCARD,DISCOVER and AMERICAN EXPRESS response to manufacturers'price changes Guaranteed Satisfaction: v'sa _ % if.1ou have tried a moduot and it is defective or does not oertorm snit satisfactorily,we ill provide a credit, refund,or exchange-,its your Avai able to iicuns>ud ;rat>#i#ion ers`in the U.S.Ai!invoices are choice, Simply call our customer service�depart,-,er t YY thin 30 days t of receipt of they merchandise,to arrange for the return. For a payable,within.3 i clays, Y^arranf,,t r;Dair or it yo {tire slat something yo:i did not cider, S:-ply call, i x Products & Controlled Substances: trx Medical 1-800-845-3550 Regulations require r<s to limit fhe sale of Rx and controlled substances only to registered,lice)sed healthcare professionals. If you are a new customer or have rere tly moved,;'lease fur?'sti us:ritl a copyl pf Your updated state registration. For controlled substances,f:<rnish a copy of your DEA certificate,verifying shippir€g address, lass!( irut s ca be ord�.red ur€1,by -:ail. International Orders: ,Please Note: ............._................... ...... We r €adly n,'e healthcare ,rofe ssionals an governments Opened handpieceS and equipment may not be returned far ti,:, ��`; '� � throughout the..orld, Sul place orders or for _"q r es on export credit,b€t 4°v ll be rE;pa r d or replaced in accordance.J fh terms and conditions,please contact cur l n erna orial Department: manufa,cti rar:4.«rrantie s,Before opening ha dpleces or :-800-845-3550 equipment,S.i Si QgeSt that"'OU check the shipping cointainer and packing list to varify that You have received exactly what you ordeied,Operied C�arnputer Sof fare is not returnable, Prescription Drug Returns Instructions: Other restrictions may also apply, A Return Authorization is Required for al!Prescription t:n.igs.Si?-:ply call our Customer arv�ce,Depa Event :1 800'84 ASS;I, ..:.._, ... .w. �+,�. . }......:.. '. .n� -:>m• <.,c_:•...:,. c... sax .<^.. ._.,.., E.M:�:.:.E:-.z r : ?a - .:. ... .n /�«.<q�}r �a..�F.i •::3�S�s$s� .i. .E .............. S�?x.. .... �.. .�. .. ,' ..' ............ .. .. :a.<r <..< ..:.....: r... :.,E'<. is ..:....�. \. k ...:�..-......,....,.,,�.,..,. ��. ..,wco.< ...,....;::::.:.;:;::w..�:,.w.W;,:,ca,•;x, :._...w.t.%:;:::a�kC<:.;c�w�..,;�...:..Dui:�.; .......s:t.......My;.t`.. ,r,,.,..:��.:::�iiC:t«�r.r......;�„,;,..�,-;� LP300 Prescribed by State Board of Accounts City Form No.201(Rev.1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice or bill to be properly itemized must show: kind of service,where performed, dates service rendered, by whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc. Payee Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 5526927-01 $1,795.50 5526927-01 $458.03 1 hereby certify that the attached invoice(s), or bill(s), is(are)true and correct and I have audited same in accordance with IC 5-11-10-1.6 20 Clerk-Treasurer VOUCHER NO. WARRANT NO. ALLOWED 20 Henry Schein IN SUM OF $ Dept Ch 10241 Palatine, IL 60055 $2,253.53 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members r 1120 5526927-01 102-670.06 $1,795.50 1 hereby certify that the attached invoice(s), or 1120 5526927-01 102-390.11 $458.03 bill(s) is (are) true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except OCT - 7 2013 Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund